St. Marguerite Mutual Beneficial Society

Application For Regular Membership

Today's Date: Name: Date of Birth: Age: Address:

City:

Country:

State:

Zip Code:

Name of Father: Name of Spouse: Phone Number: Email: Occupation: Employer:

Designation of Beneficiary

Name of Beneficiary: Relationship of Beneficiary:

Signature & Date

Leave this N/A you will sign & date once approved

Signature: Date:

We, the undersigned regular members of the St. Marguerite Mutual Beneficial Society, believe that the applicant above named is worthy of admittance to our Society as a Regular Member.

St. Marguerite Mutual Beneficial Society

Application For Regular Membership

Designation of Beneficiary

Signature & Date

Leave this N/A you will sign & date once approved

Regular Members:

Leave this N/A The Board will sign once approved